Florida is well known for its large Medicare population. Perhaps less well understood, the state ranks among the best in the nation for utilization of certain high-value health services like immunization and health outcomes related to cancer. Moreover, Florida has taken steps to address high healthcare costs by passing legislation to improve transparency for non-emergency services and allow drug importation from Canada. Florida is in the process of implementing an all-payer claims database (APCD) that will further improve the transparency of health spending in the state.
The state still has healthcare value issues to work on. With no Medicaid expansion in place, Florida has the fifth highest uninsured rate in the country and the second highest number of people that fall in the coverage gap. These coverage shortfalls are most pronounced for marginalized communities—20 percent of black adults were uninsured in 2017, which is 6 percentage points higher than the national average.
Florida ranked 41 out of 47 states plus DC, with a score of 23.8 out of 80 possible points in the Hub's 2021 Healthcare Affordability State Policy Scorecard.
Interviews with many Floridians from different backgrounds and experiences all show that healthcare in unaffordable, according to a column in The Gainesville Sun. Interviews have included stories from Florida residents like Shay P., an uninsured resident who was charged $320 for an IV in the emergency room, including $10 for each gauze that was used. Neil E. has been uninsured for about 20 years due to the high cost of insurance and earns too little to qualify for premium tax credits. Lisa M. is also uninsured and has several chronic health conditions. She has to go without other necessities in order to afford her medications. She believed that being uninsured prevented her from catching her cancer diagnosis early, as the clinic she was going to did not have the specialist care she needed. Another survey from Perry Undem and the Robert Wood Johnson Foundation found that more than 4 in 10 Floridians are delaying or skipping care due to cost and half of Floridians are not very confident that they can pay for usual healthcare services.
The presidential administration announced a rule allowing the importation of some prescription drugs from Canada, clearing the way for Florida and other states to implement programs to bring medications across the border, according to Kaiser Health News. Florida’s law—approved in 2019—would set up two importation programs. The first would focus on getting drugs for state programs such as Medicaid, the Department of Corrections and county health departments. The second program would be geared to the broader state population. Prices are cheaper in Canada due to limitations on how much pharmaceutical companies can charge for medicines. State officials said they expect the program to save the state about $150 million annually. The rule, however, does not allow states to import all types of medications, including biologic drugs such as insulin.
The federal government has approved Florida’s Medicaid waiver, giving the state authority to use out-of-state providers and hospitals to treat Medicaid patients and ensure that they qualify for reimbursement, according to Health News Florida. The providers and hospitals must either be Medicare providers or part of another state’s Medicaid network of providers to be eligible for reimbursement from Florida’s Medicaid program.
The Florida Agency for Health Care, armed with 31 percent of Florida’s total state budget, is exploring new strategies to address resident and other stakeholder concerns. For one, the state wants to focus on shifting spending upstream (towards early intervention and prevention instead of the ED) due to worry about inconsistent health outcomes. Though the state has already launched a health price finder, the agency is looking do reduce utilization of low value services, according to the Sun Sentinel. Other strategies target issues related to nursing home care, mental health, provider competition. These priorities were developed through provider and health expert convenings throughout the state.
Researchers found that spending on public health significantly reduced the maternal mortality rate (MMR) among black mothers and narrowed black-white outcome disparities in Florida, according to Milbank Quarterly. U.S. MMRs reveal considerable racial disparities and exceed those of other developed countries. Moreover, while worldwide MMRs have dropped sharply since the 1990s, the U.S. MMR appears to be rising.
Florida likely suffered the second-highest total of deaths attributed to not expanding Medicaid —2,776 between 2014 and 2017— trailing only Texas, which has an estimated 2,920 deaths, according to a report from the Center on Budget and Policy Priorities. A bill to expand Medicaid with work requirements is making its way through the legislature, but advocates fear its chances are slim, an analysis from the Miami Herald states. Legislators in the state have already shortened the time period Medicaid can retroactively pay for hospital bills and criticized the costs of Medicaid for people with disabilities.
Florida has launched the Florida Health Price Finder website, which gives residents the ability to search for prices on non-emergency medical procedures in the state, according to ABC News. Some healthcare advocates are critical because the website only provides average numbers from a few years ago, which may be out of date. Moreover, the tool does not take Medicare and negotiated rates into account. The Florida Hospital Association has also called the validity of the data into question.
A report forecasting the implications of Medicaid expansion in Florida predicts that over 800,000 Floridians would gain coverage within the first five years of expansion. Additionally, the move could free up $119.3 million in state funds and fiscal gains may occur in corrections, public health, and uncompensated care for uninsured Florida residents.
Air ambulance companies have begun advertising memberships to rural Kansans in the wake of recent hospital closures, prompting concerns that the companies are exploiting vulnerable patients, reports KCUR. Although the membership programs promise to protect customers from out-of-pocket expenses, the contractual fine print often undermines the advertised intent. For example, privately insured patients who purchase memberships would still receive a bill and must work through their insurance company’s claims, denial and appeal processes. Additionally, air ambulance companies can end memberships at any time without obligation to notify the customer. North Dakota and Montana ban or heavily regulate the memberships in attempt to better protect consumers.
Florida has passed a law eliminating certificates of need before certain hospital facilities can be built, according to BISNOW. Certificate of Need (CON) programs were implemented in the 1960s when regulators worried that the cost of maintaining largely unused hospital facilities would be passed on to consumers. These laws require healthcare providers, primarily hospitals, to demonstrate to a public body the clinical need for a capital expense, for example, a new building or major piece of equipment, prior to making these investments. Critics have argued that CON programs stifle competition. However, the Florida Hospital Association asserted that removing CON regulations would allow for duplicative services to be offered in affluent communities, while lower income and uninsured populations lose access to vital hospital services.
Florida has enacted several healthcare laws geared towards affordability. One such law would allow health insurance companies to work with providers — like hospitals — to setup a website with lists of shoppable, non-emergency services such as lab work or outpatient surgical procedures, according to Florida Voices for Health. Another bill would establish a Canadian drug-import program for state healthcare coverage, which includes 3.8 million Medicaid recipients and 100,000 state prisoners.
Florida has passed legislation authorizing the state to import prescription drugs from Canada and other countries, potentially lowering the cost of lifesaving medicines that millions of people take every day, according to AARP. The law creates two prescription drug importation programs: The Canadian Drug Importation Program focuses on bringing down the cost of drugs to state-funded programs, such as Medicaid and the state prison system; and The International Prescription Drug Importation Program allows medicines to be imported from Canada and other countries, and then purchased by consumers through wholesale distributors and pharmacies. In order to implement these programs, states need approval from the U.S. Department of Health and Human Services (HHS) to begin their programs.
The Centers for Medicare & Medicaid Services has approved a Florida section 1115 pilot program that provides behavioral health services and housing to adult Medicaid beneficiaries with serious mental illness, substance abuse disorders, or both, according to HealthLeaders. The program, called the Behavioral Health and Supportive Housing Assistance Pilot, will provide transitional housing, tenancy support services, mobile crisis management and self- and peer-support, along with home and community-based services to people who are homeless or at risk of homelessness. The hope is that the program will promote independence for beneficiaries and improve health outcomes.
Achieving widespread exchange of health information is a national health policy objective to boost treatment efficiency, reduce healthcare costs and improve patient outcomes. A recent study of Florida hospitals found that participation in health information exchange (HIE) was associated with a greater reduction in the probability of unplanned, thirty-day readmissions for acute myocardial infarction compared to nonparticipating hospitals. These findings indicate that HIE can be leveraged to improve quality measures targeted by the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program and may hold promise for achieving broader policy goals.
Telehealth has proven its value in providing much-needed mental health services to Armed Forces members and veterans dealing with PTSD. Now a Florida VA center is tweaking that platform to give veterans access to a unique form of therapy, according to an article in mHealthIntelligence. The Gainesville-based Malcom Randall VA Medical Center is seeing positive results with its Telehealth Creative Arts Therapy program, in which veterans dealing with PTSD connect via virtual visits with therapists offering treatment through music, movement and visual arts. The program is one of several telehealth services launched by the VA and Department of Defense to connect service members and veterans with healthcare outside of the often-crowded walls of the nearest VA hospital. Such programs also serve to improve access and health outcomes for veterans who can’t easily get to the nearest hospital or clinic or don’t want to go there.
Florida ranked 48th overall among the 50 states and District of Columbia on The Commonwealth Fund’s 2018 Scorecard on State Health System Performance, according to an article in Florida Politics. Among categories, the state ranked 49th for access and affordability; prevention and treatment; avoidable hospital use and cost; and providing equal access to healthcare. The state made improvements in the number of uninsured adults and children, but could have made more progress had it expanded Medicaid. There was also improvement in the number of adults who went without care because of cost, access to mental health services and treatment of breast cancer. However, many areas saw no improvement, such as 30-day post hospital mortality, and number of people who smoke, are obese, lost six or more teeth or reported only fair or poor health.
A new state opioid law is seen by many as a good first step in combating a crisis that has claimed at least 16 lives a day in the Sunshine State, according to a report from ABC News. The legislation includes tougher limits on most painkiller prescriptions, more money for treatment programs and requirements for physicians to check the state's prescription database. Opioid-related deaths across Florida have jumped 35 percent from 2015 to 2016, according to the Florida Department of Law Enforcement. Opioids were identified as either the cause of death or were present in the deceased person's body in 5,725 cases in 2016.
Rural hospitals are having trouble providing healthcare to their patients, and officials say the Florida Legislature’s budget plan isn’t likely to help, according to an article in Florida Trend. Last year, Florida’s Legislature cut $521 million from Medicaid funding—$11.4 million of which affected rural community hospitals. For example, because of state cutbacks, Doctors’ Memorial Hospital in rural Perry, Florida was paid approximately $2.5 million less than the cost to treat Medicaid patients between 2015 and 2017. It varies by hospital, but nearly half of rural patients rely on government plans like Medicare and Medicaid. Many rural hospitals also face the issue of providing care to uninsured patients who may not be able to afford their care. The Senate’s proposal offers $50 million in new funding for hospitals to balance last year’s cuts. However, the House’s budget plan would cut an additional $2.9 million in funding for rural hospitals.
The Florida state Telehealth Advisory Council on Tuesday unanimously approved a final report and legislative recommendations to remove barriers to the use of telehealth, according to a news article in WJCT. The report recommends that lawmakers require Florida health insurance plans, excluding Medicare plans, to provide reimbursement “parity” for health services provided through telehealth or in person. The report includes a limit on the recommendation to make clear that the Legislature should “not require insurers to add additional service lines or specialties, mandate fee-for-service arrangements, inhibit value based payment programs, or limit healthcare insurers and practitioners from negotiating contractual coverage terms.” Florida already has approved a nursing compact, but the recommendations would also allow compacts for physicians.
Business owners invest in quality health insurance for their employees, but if insurance companies constantly look for ways to deny employees essential treatments, they undermine business investment and impede economic growth, according to a commentary by the president of the Florida Hispanic Chamber of Commerce in the Naples Daily News. insurers regularly require doctors to obtain prior authorization for certain medications, even when the prescribing doctor has examined the patient and deemed a specific drug is necessary. This policy second-guesses doctors and values profits before expedient patient care, which can have negative implications for healthcare spending.
After receiving an “F” from Catalyst for Payment Reform for their price transparency laws, Florida passed price transparency legislation in 2016. A report from Public Agenda explores how Floridians are trying to find and use healthcare price information, their attitudes about prices, and how their attitudes and behaviors compare to those of Americans overall. Notable findings include: 56 percent of Floridians attempted to find information about health care prices before getting care, including 24 percent that tried to compare prices across multiple providers. Of those that compared prices, 62 percent reported saving money. A vast majority of Florida residents, 84 percent, feel that it is important for their state government to provide people with comparative price information.
In a study released earlier this year, researchers looked at charges at 20 Florida hospitals during the three months before the negative publicity and again during the same three month period the following year. There was no evidence that negative publicity resulted in any reduction in charges. Instead, the charges were significantly higher following the publicity. In addition, the 20 hospitals studied were less likely than other Florida hospitals to achieve three or more stars in the quality metrics system used by CMS.
Florida doctors from Health First have settled a nearly $350 million antitrust suit, according to Modern Healthcare. Omni Healthcare alleged that Health First had participated in an illegal “hospital monopoly” by acquiring Melbourne Internal Medicine Associates in 2013. Health First faces other lawsuits claiming that they have participated in anticompetitive behavior.
State regulators have appointed thirteen healthcare professionals to assess the viability of telemedicine, according to Health News Florida. The board will look at how out-of-state doctors could participate and the rate at which the physicians will be reimbursed by insurance companies. The board will spend a year composing these recommendations.
The U.S. Justice Department has brought the largest criminal case of healthcare fraud ever against individual suspects, according to NPR. The indictments accuse three Miami-Dade County healthcare workers of leading "a complex and profitable health care fraud scheme that resulted in staggering losses — in excess of $1 billion," said Special Agent in Charge George L. Piro of the FBI's Miami field office.
Florida has the least expensive health services, but the cost of health services varies widely throughout the state, according to a Health Affairs study examining price variation. The study compared overall price levels by state and price variation within states. The authors found that there was sometimes more than a threefold variation in healthcare prices. In Florida, for example, the price of a pregnancy ultrasound varied from $180 in Orlando to $457 in Jacksonville.
Florida is now the second state behind New York to shield consumers from expensive surprise medical bills, as Governor Rick Scott signed into law legislation that would protect patients from balance-billing in both emergency and non-emergency hospital situations, according to The Consumerist
The measure, introduced last fall and passed by the state’s legislature last month, aims to put a stop to unfair and unexpected out-of-network charges that affect nearly 30% of privately insured Americans.
Florida Gov. Rick Scott made a pitch for his hospital transparency legislation that would require hospitals to disclose what they charge for their services, according to FloridaPolitics.com. In May, Scott created the Commission on Healthcare and Hospital Funding to look at ways government spending on healthcare can be more efficient. Scott and the board heard from Floridians who reported price gouging, and Scott said his proposal would attempt to put a stop to that.
A coalition of consumer groups, healthcare providers and unions urged Florida's insurance regulator Wednesday to reject the two proposed mergers among health insurance giants over concerns that less competition will mean higher rates, less choice and lower quality of care for Floridians.
Health News Florida: A House Republican on Friday proposed creation of a program that would offer financial help to dentists who practice in underserved areas. The bill (HB 139), filed by Rep. Travis Cummings, R-Orange Park, will be considered during the 2016 legislative session and follows years of discussion about a lack of dentists in some low-income parts of the state.
After two years with its regulatory hands tied, the Florida Office of Insurance Regulation is free this year to challenge insurers again — in a market seeing double digit hikes, according to the Miami Herald. A 2013 law barred the Florida Office of Insurance Regulation from regulating proposed rates in Affordable Care Act plans, stating that the state office could not have a final say over federal laws and regulations such as the ACA. That law expired this year.
In 2012, according to a New York Times analysis of Medicare data released last year, more than twice the number of nuclear stress tests, echocardiograms and vascular ultrasounds were ordered per Medicare beneficiary in doctor’s offices in Florida than in Massachusetts—leading some to call Florida an epicenter of Medicare abuse. This story explores reasons for high volume in Florida.
This study examined Florida’s 2006 Medicaid Reform, which mandated that Medicaid beneficiaries switch from the state’s FFS system to (1) insurer-owned plans, (2) hospital-owned plans, or (3) physician-owned plans. The study found that insurer-owned plans reduced costs by 7-12% in all markets, but insurers in different markets reduced costs in different ways. The results suggest that insurers have leverage in how they reduce costs, but that competition with provider plans may restrict their options.
This story found that an emergency room visit to an out-of-network hospital resulted in even higher bills than if the patient had been uninsured.
The Florida Agency for Health Care Administration published the Florida Healthcare Expenditures report for calendar year 2012. The report found that total personal healthcare expenditures increased 3.1 percent between 2011 and 2012, down from a 3.4 percent increase between 2010 and 2011. This is the second smallest annual increase since the 1993 inception of the report.